Amniotic Membrane Transplantation in Stevens–Johnson Syndrome

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent a spectrum of severe, immune-mediated, mucocutaneous disease secondary to exposure to drugs or infection. SJS/TEN has up to a 35 % mortality rate. Ocular sequelae are the most significant chronic complications of SJS/TEN in survivors. These chronic sequelae can be prevented or lessened by appropriate management in the acute phase of the disease. Visual prognosis and long-term health of the ocular surface lies in the presence and degree of acute eye and eyelid involvement. Amniotic membrane transplantation (AMT), when done correctly in the acute phase, has been shown to decrease chronic ocular surface disease from SJS/TEN. AMT involves the use of amniotic membrane, the innermost layer of the placenta, which consists of a thick basement membrane and an avascular mesenchymal layer. The exact mechanism by which AMT is beneficial is not fully understood, but amnion has antimicrobial and immunomodulatory properties and promotes epithelialization. This procedure can either be done at bedside or in the operating room. Patients who are in a burn intensive care unit and sedated may not need additional anesthesia and the procedure can be done at bedside. Adults who are awake and alert can oftentimes have the procedure performed at bedside with local anesthetic only. Children who are awake and alert will need general anesthesia requiring an operating room setting. The commercial source of amnion in the USA, Bio-Tissue, now has 10 × 5 cm amnion sheets available. However, if unavailable, three of the smaller 3.5 cm² amnion pieces can be sutured together to create a single 3.5 × 10.5 cm piece.